AB0917 A randomized, usual care controlled, parallel-group pragmatic clinical trial in an interdisciplinary combined dermatology–gastroenterology–rheumatology clinic; preliminary data on baseline characteristics of 128 patients and questionnaire-based qualitative data from 30 patients and 15 HCPs
Authors: T. B. Laurberg, A. G. Loft, A. K. Dige, J. S. Agnholt, L. F. Møller, K. F. Hjuler, L. Iversen
Journal: Annals of the Rheumatic Diseases (2022)

Background Immune-Mediated Inflammatory Diseases (IMIDs), including psoriatic arthritis (PsA), axial spondyloarthritis (AxSpA), psoriasis, hidradenitis suppurativa, and inflammatory bowel disease share both pathophysiological and environmental factors, individuals with one IMID have an increased risk for developing other IMIDs, and are associated with reduced health-related quality of life, increased risk of comorbidities, and reduced socioeconomic status. Unmet needs in care of patients with IMIDs may result from lack of patient-centricity in the usual mono-disciplinary siloed approach to these diseases. Objectives The overall aim of this study is to determine the effectiveness of an interdisciplinary combined clinic intervention compared to usual care in patients with the aforementioned IMIDs. Methods This is a randomized, usual care controlled, parallel-group pragmatic clinical trial. 300 consecutively enrolled participants with co-occurrence of at least two IMIDs are randomly assigned 2:1 to either treatment in the interdisciplinary combined clinic or usual care. The study consists of a 6-month active intervention period and a 6-month follow-up period. Primary outcome is change from baseline to 24-Weeks on the Short-Form Health Survey (SF-36). Additional questionnaire-based qualitative date from 30 patients and 15 health-care professional (HCP)s involved in the center are reported. Results Here we report baseline characteristics of the first 128 patients (mean age: 45.4y, 18–74.2, females (83, 64.8%)). All patients had ≥2 IMIDs: Psoriasis (99, 77.3%), PsA (peripheral) (72, 56.3%), AxSpA (34, 26.6%), Hidradenitis (16, 12.5%), Crohn (35, 27.3%), Colitis (20, 15.6%), AxPsA (9, 7.0%), IBD-associated arthritis (10, 7.8%), HS-associated arthritis (1, 0.8%). HLA-B27 was positive in 24 (22.2%) patients. Advantages, challenges and themes mentioned by the patients are listed in Table 1. Table 1. Advantages and challenges on feedback from 15 HCPs and feedback from 30 patients. Advantages - HCP Challenges - HCP Themes mentioned by the patients Professional development Culture -Old habits from regular departments-“This is how we usually do this” Communication between HCOs improved treatment Satisfying to work on a high professional level Create a new culture takes time and patience-Large differences between specialties and subject areas Collaboration between HCPs improved treatment Improved perspective on diseases and patients Logistics, physical requirements Holistic approach –patients felt HCPs cared for all health aspects Collaboration – professional, personal, team spirit Shared goals Confidence in living with diseases Meaning full to work with all aspects of disease Time and patience Coherence Effective communication Optimal use of time and resources Treatment optimization Learning can be brought back to “monodisciplinary” work (improved treatment in respective departments) Clarification about diet, mastering fatigue and work-related problems Broader disease focus Avoid patient being information carrier Reflection A statement from a patient: “It gave me much more peace of mind that I should not “split” my health problems and run errands between different departments. Didn’t have to tell the same issues in several places or even try to figure out who to say what to, or who can answer a given question.” Conclusion In conclusion, an interdisciplinary combined clinic based on an inflammation medicine holistic concept has been successfully established. Preliminary results indicate a high value of an interdisciplinary combined clinic in patients with IMIDs, and HCPs find both advantages and challenges in establishing a combined clinic. Disclosure of Interests None declared